单侧腰椎一髂骨椎弓根钉棒系统在骶髂关节结核手术中的临床应用

Clinical application of unilateral lumbar-iliac pedicle screw system in surgical treatment of sacroiliac joint tuberculosis

目的探讨单侧腰椎一髂骨椎弓根钉棒系统在治疗骶髂关节结核中的应用价值。方法选取青岛市胸科医院2007年1月至2014年12月临床确诊为骶髂关节结核的16例患者作为研究对象，包括男10例，女6例；年龄21～55岁，平均（38．0±5．2）岁；Kim分型，Ⅲ型5例、Ⅳ型11例。采用单侧腰椎一髂骨椎弓根钉棒系统对研究对象进行手术治疗，术前给予抗结核药物治疗、进行常规检查、疼痛视觉模拟评分（visual analogue scale，VAS）。术后进行随访，观察患者影像学变化，并于末次随访时进行VAS评分。结果本组16例患者手术时间平均为（118±21）min、出血量（402±76）ml，手术切口均I期愈合。16例患者术后随访时间为15~76个月，平均23个月，均无局部结核复发，术后3～7个月全身结核中毒症状消失。CT扫描显示，患者植骨均于术后6个月达骨性融合。16例患者术前VAS评分为（7．58±1．20）分，高于末次随访的（1．02±0．75）分，差异有统计学意义（t=9．47，P〈0．05）。结论单侧腰椎-髂骨椎弓根钉棒系统内固定病灶清除植骨融合治疗骶髂关节结核，可以迅速恢复骶髂关节的稳定性，缓解患者的临床症状。

Objective To evaluate the clinical effect of unilateral lumbar-lilac pedicle screw system in treat ment of sacroiliac joint tuberculosis. Methods Clinical data were collected for 16 patients diagnosed as sacroiliac joint tuberculosis in Qingdao Chest Hospital from January 2007 to December 2014. There were 10 male and 6 female patients. Ages were between 21 and 55 years old, with an average of （38.0±5.2） years. According to the Kim classification system, 5 cases were type m and 11 eases were type IV. Research objects were treated with unilateral lumbar-lilac pedicle screw system in surgery. Before surgery, anti tuberculosis medicine and routine examination were given and visual analogue scale （VAS） was evaluated for pain. All patients were followed up after surgery. The changes in imageology were recorded, and VAS scores were taken with the last follow up. Results The surgery took an average of （118±21） minutes for the 16 patients; bleeding volume was （402±76） ml; surgical incisions were all primary healing. The follow up time were 15- 76 months after surgery, with an average of 23 months. There was no regional tuberculosis relapse for all 16 patients, and the general symptom of tuberculosis disappeared after 3-7 months of surgery. CT screening showed bone grafts fusion 6 months after surgery. The VAS scores for the 16 patients were （7.58±1.20） before surgery, higher than （1.02 ± 0.75） in last follow up. The difference was statistically significant （t= 9.47, P〈0.05）. Conclusion Unilateral lumbar-lilac pedicle screw fixation system could clear disease focus, reach bone graft fusion and cure sacroiliac joint tuberculosis. It could rapidly restore the stability of sacroiliac joint and relieve clinical symptoms of the patients.